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All requested information must be supplied before we can set up your AEPSi annual subscription. **NOTE: You _must_ have a pending AEPSi Subscription order number to complete this form.** ### AEPSi Order Info AEPSi Order Number (e.g. Purchase Order, Web Confirmation, Invoice)\*\* AEPSi Annual Subscription Service Requested\* Subscription ServiceAEPSi Pro (individual program account) $199.95 annuallyAEPSi Enterprise (multi-program account) $999.95 annually Unsure about which account type to select? Review the features of each account [here](https://aepsinteractive.com/wp-content/uploads/2024/01/AEPSi_Account-Features_2024.pdf). ### Account Details Account Country\* CountryUnited StatesCanadaAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Account Name\* Account Address Line 1\* Account Address Line 2 Account City\* Account State\* StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Account Province\* ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Account State (Intl.)\* Account Zip/Postal Code\* Account Phone Number\* Account Phone Number\* ### Subscription Administrator Details The Subscription Account Administrator designated below will be the individual to receive the initial welcome/login email to set up your program’s AEPSi annual subscription. This person can set up other users and designate roles (including other Account Administrators), as well as set up program information, and child profiles, etc. Subscription Administrator Name\* Subscription Administrator Phone\* Subscription Administrator Phone\* Email\* ### Choose Your Subscription Start Date! AEPSi annual subscriptions may only start on the 1st, 5th, 10th, 15th, 20th, or 25th of any given month. If you select a start date that falls on a weekend or holiday, access will be granted the following business day. **Same day startups are not possible.** Please select an applicable **FUTURE** start date for your subscription. Subscription Start Date\* MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Subscription Start Date\* Date5th10th15th20th25th Subscription Start Date\* Date1st5th10th15th20th Subscription Start Date\* Date1st5th10th15th20th25th ### Set a Maximum Child Seat Limit (optional) You may choose to set a maximum limit on the number of Child Seats that can be active in your account at one time. Archived Child Records are not included in the total count. You can adjust the limit at any time on your AEPSi Account Details page. If you’d like to set a maximum now, please enter the number below or opt out of a limit. Choose Limit\* Set limit or opt outSet limitI do not want to set a maximum number for Child Seats in my account. Users can create an unlimited number of Child Seats. Maximum Child Seats\* ### Terms and Conditions By checking here and submitting this form, I certify that I understand:\* AEPSi Child Seats are billed annually in arrears based on actual program seat usage at the end of the subscription year. The annual Child Seat usage statement may vary and will be billed according to the actual number of Child Seats used at the applicable tiered per-Seat rate for each Child Seat used. This usage fee is separate, and above and beyond, the annual subscription service fee. By checking here and submitting this form, I certify that I understand:\*\* AEPSi is an “opt-out” subscription, meaning this subscription will automatically renew each year unless the customer informs vendor (Brookes Publishing) of intent to cancel prior to the start of a new subscription year. AEPSi Annual Subscription fees are invoiced each year in advance and are payable prior to your subscription renewal date. Customers will receive a renewal invoice notice via USPS mail approximately 90-days prior to the end of the annual subscription period. Electronic Signature and Job Title\* Please type your name and job title. Typing your name here constitutes your signature and agreement to begin your annual AEPSi subscription with the details provided herein and subject to the Terms & Conditions. ### Comments and Questions Do you have any additional comments or info you’d like to share? - [_Facebook_](http://www.facebook.com/brookespublishingco) - [_Twitter_](https://twitter.com/BrookesPubCo) - [_Pinterest_](http://pinterest.com/brookespubco/) - [_Blog_](http://blog.brookespublishing.com/) **Brookes Publishing** P.O. 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